RADIOFREQUENCY CATHETER ABLATION OF ACCESSORY ATRIOVENTRICULAR PATHWAYS IN CHILDREN AND YOUNG-ADULTS

Objective-To assess the efficacy of radiofrequency ablation for reentr ant tachyarrhythmias in children and young adults. Setting-A tertiary cardiac referral centre. Patients and interventions-Over a 16 month pe riod 22 patients aged less than 20 years (median age 16.5 years) under went 26 radiofrequency ablation procedures for atrioventricular reentr y tachycardia through an accessory pathway. The results of radiofreque ncy ablation were compared with those in a group of 16 patients (media n age 14 years) who had had surgical ablation for atrioventricular ree ntry tachycardia over a preceding six year period. Results-Ablation of an accessory atrioventricular pathway was accomplished for 18 (76%) o f 25 pathways in 16 (73%) of 22 patients. There were no procedure-rela ted complications. Surgery was eventually curative in 15/16 patients ( 94%). However, three patients required a second open heart surgical pr ocedure because tachyarrhythmia recurred. There were no surgical death s. Failures for radiofrequency ablation were related to accessory path way location, and were greater for right free wall and posteroseptal p athways (success rate of 50% and 57% respectively). Recurrence after s urgery was also associated with pathways in these locations. Conclusio ns-Transcatheter radiofrequency current ablation was safe and achieved a cure with less patient morbidity and improved cost efficiency. It i s an attractive alternative to long-term drug therapy or surgery in ol der children and adolescents. A higher success rate may be expected wi th increased experience.